Asia Pacific Allergy最新文献

Introduction: We aimed to investigate clinical and laboratory parameters that can predict clinical response in patients who completed subcutaneous immunotherapy (SCIT) against house dust mites (HDM) and to determine parameters associated with systemic adverse effects (SAE).

Methods: In total, 108 patients who had complete medical data were evaluated.

Results: Around 54.6% of patients were male; mean age was 11.7 ± 3.1 years. All patients had allergic rhinitis, 86% had asthma, and 22% had atopic dermatitis. After SCIT, mean symptom score (SS) for allergic rhinitis had decreased in 86% of patients, asthma severity had decreased in 35.5% of asthma patients. After SCIT, median eosinophil count and HDM skin prick test (SPT) diameters decreased, there was not statistically significant change in total IgE (P = 0.001, 0.001, and 0.824, respectively). No statistically significant difference was detected between the SS change groups (decreased, same, or increased) in terms of age, gender, disease duration, presence and severity of asthma, presence of atopic dermatitis, duration of SCIT, time after SCIT, initial sensitization status, total IgE, eosinophil and basophil counts, and SPT diameter for HDM. However, in the group with decreasing SS, total IgE change (in direction of decrease) was found to be statistically significantly higher (P = 0.008). SAEs were observed in 15.7% of patients, 0.41% of injections. SAEs were more common in girls (P = 0.023). Initial eosinophil count, basophil count, and dermatophagoides farina SPT diameter were statistically significantly higher in group with SAE (P = 0.007, 0.008, and 0.036, respectively).

Conclusion: HDM-specific SCIT is a treatment that provides reduction in allergic rhinitis symptoms and asthma severity in children. However, we could not identify any clinical or laboratory findings that could predict clinical success before treatment. Girls and patients with high eosinophil and basophil counts should be monitored more carefully for the development of SAE.

Background: Food protein-induced allergic proctocolitis (FPIAP) is a non-IgE-associated disease, although some evidence exhibits IgE sensitization in a minority of patients.

Objectives: This study aimed to determine the prevalence of IgE sensitization to common foods using skin tests and assess milk outgrowing in infants with FPIAP over a 5-year follow-up period.

Methods: This prospective study included infants with FPIAP in 2017. Skin prick tests were done using commercial extracts of 11 common food allergens. Infants were followed for 5 years, and the resolution was established by successfully ingesting cow's milk.

Results: Of 126 infants analyzed, 81 infants (40 boys and 41 girls) with FPIAP completed this study. The frequency of food sensitization was 32% to at least one of the applied food allergens. Cow's milk (13.6%), egg (13.6%), and beef (6.2%) were the most frequent allergens, respectively. In this study, 45.7% of the infants developed a tolerance to the milk by the age of 1 year, 77.1% by the age of 2, 91.3% by the age of 3, and 96.3% by the age of 4. The rate of sensitization to milk was significantly different based on the tolerance time of early onset and grated late start for cow's milk (P < 0.001).

Conclusion: This study suggests pointing out skin tests of infants with FPIAP for common food allergens because IgE-mediated sensitization can infer a greater chance of a persistent course of milk intolerance.

Angioedema with eosinophilia is a rare condition characterized by marked eosinophilia and nonpitting edema. Nonepisodic angioedema with eosinophilia (NEAE) is more common in Japan than in other countries. This study analyzed 12 NEAE cases from Akita Prefecture and 70 cases from the literature to examine clinical features and seasonal patterns. In the Akita cases, patients were predominantly women (91.6%) and in their 20s to 30s. Edema mainly affected the lower legs and dorsum of the hands, with common symptoms, such as arthralgia (50%) and skin issues (50%). The mean eosinophil count was 4,678/µL, and most cases occurred from late summer to autumn. The literature review showed similar demographics to those of the Akita cases, and 87.1% of the patients were women in their 20s to 30s. Common symptoms included weight gain (37.1%) and arthralgia (37.1%), with a mean eosinophil count of 8,914/µL. Over half of the patients had onset between September and December. NEAE cases appeared more frequently during peak Mycoplasma pneumoniae infection outbreaks in Akita Prefecture, and both conditions tended to occur predominantly in autumn and winter, suggesting a possible association. These findings highlight a potential association between NEAE and M. pneumoniae infections, possibly through mechanisms such as molecular mimicry. Further large-scale studies are required to clarify NEAE's pathogenesis.

Background: Cough is one of the multiple prolonged symptoms observed in patients who had coronavirus disease 2019 (COVID-19) infection.

Objective: We assessed the clinical outcomes and identified factors contributing to cough persistence in patients post-COVID-19.

Methods: This retrospective cohort study included adults who visited a specialist cough clinic between 2022 and 2023. All participants underwent systematic investigation and treatment for persistent cough. Cough persistence was assessed at the 2- and 12-month follow-ups. Participants were classified as having persistent cough if they had a current troublesome cough at the 2- and 12-month follow-ups, and a cough severity visual analog scale (VAS) score change below 30.

Results: Sixty-six patients (mean age 48.7 years; 72.7% women) were analyzed and divided into 2 groups: persistent cough (33.3%) and remitted cough (66.7%). The persistent cough group had a significantly higher prevalence of abnormal laryngeal sensation, sputum production, breathing difficulty, and airway eosinophilia; their VAS score changes at 2 months were also lower. Multivariable analyses indicated associations between persistent cough at 1 year and factors such as airway eosinophilia (adjusted odds ratio [aOR], 6.78), abnormal laryngeal sensation (aOR, 6.42), and low cough VAS reduction (aOR, 1.05).

Conclusion: Persistent cough remained a significant issue for one-third of the patients after COVID-19. The clinical features commonly observed in chronic cough were also present in those who have experienced COVID-19, which contributed to prolonged cough. These findings underscore the need for systematic assessment and tailored treatment strategies to effectively manage persistent cough in patients post-COVID-19.

A 61-year-old man was referred to the immunology clinic due to prolonged COVID-19 infection and absent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. His infection, confirmed by polymerase chain reaction (PCR) testing upon returning to Hong Kong from Vancouver, resulted in a 31-day hospitalization due to persistent positive PCR results, despite his remaining asymptomatic. Laboratory tests revealed lymphopenia, low immunoglobulin levels, and unremarkable serum protein electrophoresis, with all viral serologies, including HIV, being negative. Although he received 3 doses of the Pfizer BioNTech vaccine, he showed no detectable SARS-CoV-2 antibodies. Further evaluation indicated almost-absent CD19 cells and low CD4 and CD8 counts, and coupled with his history of thymoma, this led to a diagnosis of Good syndrome. The patient began subcutaneous immunoglobulin replacement therapy and was started on long-term valganciclovir for moderate cytomegalovirus antigenemia.

Background: In the United States, food allergies (FAs) disproportionately affect children based on their racial or ethnic heritage, though there are some gaps and discrepancies in the literature about the prevalence of FAs among different groups.

Objective: The objective was to analyze clinical data to determine how FA prevalence varies based on race and ethnicity and to track FA diagnosis rates over time.

Methods: Patient FA diagnoses, birth years, and self-reported races or ethnicities were analyzed for 298,476 pediatric patients in the Children's Hospital of Philadelphia network. Odds ratios (OR) for FA were calculated for each race or ethnicity, controlling for sex, insurance type, and birth year. The percentages having each of the top 9 FAs and ORs for being allergic to a particular allergen and multiple allergens were calculated for each race or ethnicity using a subset of data for 20,582 food-allergic children. The percentages of each birth cohort diagnosed with FA were plotted.

Results: Asian/Pacific Islander (A/PI) children had the highest odds of FA (OR, 1.92; CI, 1.80-2.05) and multiple FAs (OR, 1.55; CI, 1.37-1.76). The most common allergens varied between groups. All groups had higher odds than White children of allergies to fish and shellfish, but only A/PI children also had higher odds of peanut, egg, wheat, and sesame allergies. FA diagnoses appeared to increase until the 2004 birth cohort and remain steady through the 2008 birth cohort.

Conclusions: Clinicians, researchers, and outreach coordinators should be aware of the potential for a significantly greater risk of FA for children of A/PI heritage in the United States. Additional studies that intentionally include patients from these demographics and monitor FA trends over time are warranted.

Background: Patients with allergic rhinitis (AR) and bronchial hyperreactivity (BHR) may be at higher risk of developing asthma.

Objective: The study was to investigate whether reactivity to house dust mites (HDM) and serum IgE level can be used to predict BHR.

Methods: A total of 75 asthmatic patients were included in the study. All patients performed spirometry and underwent a bronchial challenge with histamine.

Results: Seventy-five patients with HDM-positive skin prick tests who underwent airway provocation tests were included in this study. Small airway dysfunction was found in 19 patients. After the histamine challenge, the change of forced expiratory volume in the first second (FEV1) was more than 15% in 48 patients and more than 20% in 42 patients. There were positive associations between serum IgE levels and FEV1 fall value. The following cutoff values showed the best combination of sensitivity and specificity for AR with BHR: Serum total IgE 104.2 IU/mL (area under the curve [AUC]: 0.711, P = 0.0019), Dermatophagoides pteronyssinus-specific IgE 13.7 IU/mL (AUC: 0.799, P < 0.0001), Dermatophagoides farinae-specific IgE 27.8 IU/mL (AUC: 0.743, P = 0.0009).

Conclusion: AR patients with HDM allergy have small airway dysfunction and airway hyperresponsiveness, and airway hyperresponsiveness is related to the degree of allergy. Simple measurement of allergen-specific IgE may be the best predictor of HDM-induced asthma in patients with AR.